Asking Congress to stave off reimbursement cuts may be tough amid a climate of fiscal discipline that has brought several rounds of reductions over the past two years. Gene Sperling, director of the National Economic Council in the Obama administration, told attendees that provider cuts are part of the White House's effort to deliver savings “in a balanced way.”
Sperling, who did not take questions from the audience, repeated the administration's preference for a deficit-reduction agreement that includes raising revenue along with cutting spending. He also said that the administration recognizes that dealing with the nation's "long-term and healthcare entitlement challenge" must be an integral part of any long-term fiscal strategy.
For the first time in more than 30 years, the AHA is hosting its annual conference in Washington while federal lawmakers are out of town on a weeklong congressional recess. Even so, hospital members should not be deterred from meetings on the Hill, nor should they underestimate how valuable staff members are to lawmakers, Pollack said. He called many of these legislative aides key players who can "move beyond the politics and posturing" and who often draft legislation. And to underscore the importance of these roles, Pollack noted that 20 senators and 78 representatives served as congressional staffers earlier in their careers.
"This is a unique opportunity,” Pollack said. “While they may be back home, or someplace else, their staffs remain on Capitol Hill," Pollack said. "And with Congress officially out of session, they will have more time and can pay more attention to discussing our issues."
Pollack said the next significant date for the federal budget could come as early as late July when the United States again reaches the debt ceiling—an event that could also be pushed back until the fall.
"We don't know whether there will be a grand bargain. We don't know whether there will be another temporary solution or tax. But we do know that there will be pressure to cut spending," Pollack said in the opening plenary session at the Washington Hilton. And Medicare and Medicaid, because they make up 22% of the federal budget, he continued, “will be right in the middle of those discussions yet again.”
"That's why Congress needs to reject arbitrary funding cuts for hospital services and support structural reforms that will improve these programs for the future. We need to educate staff on the challenges we face in absorbing the $250 billion in budget reductions already on the books—that includes the sequester."
In addition to those payment reductions, hospital executives should push for the federal government to delay the DSH cuts in both Medicare and Medicaid that were included in the health reform law, Pollack said. Those cuts were supposed to be phased in as coverage for uninsured patients expanded, but those expansions are not happening as quickly as hospitals had anticipated. Citing the Congressional Budget Office, Pollack said about 5 million fewer people are likely to be covered under the law. And in addition to those cuts, the law called for redesigning both DSH programs. A late-Friday payment rule from the CMS included a proposal to change the way Medicare DSH cuts would flow.
"We are carefully analyzing that proposal and we have formed a membership advisory committee to be led by our former Chair Teri Fontenot to provide us with advice on how we should respond," Pollack said. He added that the AHA does not know when the CMS will release a proposed rule on how to change Medicaid DSH payments, but that the organization has established a similar advisory committee to examine the issue. Bea Grause, president and CEO of the Vermont Association of Hospitals and Health Systems, will oversee that group.
Pollack also urged members to advocate their support for the Medicare Audit Improvement Act, legislation he said will provide some regulatory relief in the area of recovery audit contractors.
"As you may know, roughly half of RAC denials for medical necessity are for claims where the RACs said the treatment should have been provided on an outpatient basis, rather than an inpatient setting," Pollack said. "No one questions that the care provided was necessary. But in these cases, CMS not only denies the claim but it doesn't permit full payment for services provided on an outpatient basis."
Pollack received strong applause when he said it's time for Congress to enact that bipartisan legislation, which Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) have introduced in the House and Sens. Roy Blunt (R-Mo.) and Mark Pryor (D-Ark.) are expected to introduce in the upper chamber when the Senate returns.
Doug Leonard , president of the Indiana Hospital Association, said he enjoyed what he called Pollack's "firebrand, rousing-the-crowd approach." He acknowledged that the congressional recess is likely why attendance among Indiana hospital executives is lower this year, to about 20 CEOs from about 30 in previous years. Despite a lower turnout, Leonard has rallied his troops to meet with staff members of Indiana's delegation in a meeting Tuesday on Capitol Hill.
"We have to champion these things, because we're constantly fighting to get paid adequately and to get paid for the right things," Leonard said. "So it is a message we have to be willing to carry strongly when we come out here."
Follow Jessica Zigmond on Twitter: @MHjzigmond
